Cardiac Arrest

Question 1

Describe the BLS primary survey.

Answer 1

Airway - open?
Breathing - are they?
Circulation - feel for carotid for at least 5 sec, but not more than 1- sec, if none - do CPR
Defibrillation if AED

Question 2

What are the ACLS secondary survey aspects for airway?

Answer 2

get an airway: head tilt, jaw thrust, oropharyngeal airway, nasopharyngeal airway, or endotracheal intubation

Question 3

What are the aspects of the ACLS secondary survey for breathing?

Answer 3

rise/fall of chest
auscultate breath sounds
monitor end-tidal CO2
chest x-ray to ensure appropriate ET tube placement

Question 4

What are the aspects of the ACLS secondary survey for circulation?

Answer 4

get IV or IO access and place on cardiac monitor

administer appropriate drugs based on ACLS guidelines

Question 5

What are the ACLS drugs you can safely give via an ET tube if IV or IO access has not been established?

Answer 5

NAVEL

Naloxone
Atropine
Vasopressin
Epinephrine
Licodaine

Question 6

What is the differential diagnosis for cardiac arrest?

Answer 6

hypovolemia
hypoxia
acidosis
hypothermia
tension pneumo
cardiac tamoponade
lyte abnormality
OD
trauma
acute coronary syndrome

Question 7

What are some things that will improve survival from a witnessed arrest?

Answer 7

initiation of bystander CPR

initial shockable rhythm

rapid defibrillation

initiation of ACLS by a trained professional within 10 minutes of the arrest

Question 8

What are the shockable rhythms?

Answer 8

pulseless ventricular tachycardia or ventricular fibrillation

Question 9

What is the initial drug in the ACLS protocol?

Answer 9

epinephrine 1 mg

Question 10

How often is epinephrine given?

Answer 10

every 3-5 minutes

Question 11

What drug can be substituted one time for the first or second dose of epinephrine?

Answer 11

vasopressin 40 units

Question 12

If epinephrine and vasopressin don’t work, what other antiarrythmics can you consider to get someone out of VF?

Answer 12

amiodarone
lidocaine

magnesium if in torsades

Question 13

Epinephrine and vasopressin can also be used for PEA and asystole, with the addition of what additional medication?

Answer 13

atropine

Question 14

How much atropine and how often?

Answer 14

1 mg and may be repeated every 3-5 minutes for a total of 3 doses

Question 15

True or false: transcutaneous pacing for asystole has not been shown to improve survival.

Answer 15

true

Question 16

What is the most important prognostic factor in cardiac arrest outcome?

Answer 16

duration of the arrest

resuscitation efforts more likely to be successful if under 20 minutes

Question 17

Of the patients who have a ROSC, what percentage will survive until hospital discharge?

Answer 17

only 50%

Question 18

What are the inclusion criteria for therapeutic hypothermia?

Answer 18

1. patients resuscitated after out-of-hospital witnessed arrest with VT/VF as initial rhythm
2. resuscitation initiated by EMS within 5-15 minutes of arrest
3. No more than 60 minutes to ROSC
4. persistent coma after ROSC
5. adult age
6. endotracheal intubation and mechanical ventilation

Question 19

What should they be cooled to and for how long?

Answer 19

32-34 degrees C

12-24 hours

Question 20

What are the contraindications to therapeutic hypothermia?

Answer 20

1. severe cardiogenic shock despite fluids and inotropes
2. cause of coma other than cardiac arrest
3. pregnancy
4. known coagulopathy
5. life-threatening arryhtmias
6. initial temperature less than 30 C
7. preexisting DNR status
8. pediatric patients